The History of the Siege of Lisbon by Jose Saramago Annotated Bibliography

The History of the Siege of Lisbon by Jose Saramago - Annotated Bibliography Example The author questions the reason why the proofreader alters the story and includes the word not which changes the whole story. Barosso’s article is about the interview of Saramago about his novel the history of the Siege of Lisbon. The interviewee conducted the interview some days before Saramago was officially crowned the Nobel Prize for Literature. The interviewee focuses on the biography of Saramago and gives us deep insight in what actually happens in life. Borosso also goes ahead and finds out the reason behind the passion behind the literature for the Portugal man. When Saramago was asked about what he would do when he wins the coveted prize, he replied, â€Å"I will not take on the duties of the Nobel as would the winner of the beauty contests, who has to be shown everywhere†¦ I don’t aspire that kind of throne, nor could I, of Course†. The interview reveals how Saramago is a down to earth person but most astonishingly he says he does not miss Lisbon especially after he sought refuge in another country due to controversies surrounding his writings. Saramago confesses that he is a person who doesn’t complicate his life. This is a primary source of reference which is very useful in building up a thesis. It is an interview of the author of the novel. The interview also contains some of his real life experiences which can play a major role in building up the thesis of my research. In addition to this the excerpts from the interviews can also be in strengthening my research objectives and questions. When Evans visited Palestine he decided to pose and talk to Saramago concerning what is happening in Palestine. He interviews Saramago concerning what was actually happening in Palestine in reference to his novel the History of the siege of Lisbon. The interviewee is keen to extract information about what he thinks is happening in Palestine is relevant to what he wrote some times back.

Improving Quality of Care Through Pain Management

Improving Quality of Care Through Pain Management Patrick Bobst A Qualitative Study Quantitative research involves testing hypotheses, making predictions, studying specific variables, collecting numbers and statistics, identifying statistical relationships, and making observations under controlled conditions (Johnson Christensen, 2008). None of the aforementioned attributes appear in chapter 17 â€Å"Improving the quality of care through pain assessment and management†. Hence. this chapter written byWells, Pasero, McCaffery, (2008) is a detailed deductive qualitative analysis which aims to increase opportunities to develop empirically supported ideas and theories with applicable relevance in the field of pain management for healthcare practitioners. Unlike inductive analysis, applied when not enough former knowledge about a phenomenon is known, deductive content analysis is used when the structure of analysis is initiated based on previous knowledge and with the intent to test a theory(Elos Helvi, 2008). The authors of chapter 17 provided qualitative resea rch by studying the issue of pain control as a whole without immersion into variables. They defined the purpose of the study by subjectively understanding and interpreting interactions with words, identifying patterns and themes, and making observations of occurrences in a natural environment(Johnson Christensen, 2008). Qualitative research is more concerned with describing social meaning and therefore provides the flexibility to follow ideas and explore processes(McGonigle Mastrian, 2012). Research Problem The level of pain a patient experiences is emerging as the fifth vital sign in health assessments statuses (Ju-Ling Wen-Chu, 2013). Pain is a common occurrence and an expectation in hospitalized patients especially during the postoperative period; yet despite the availability of analgesics along with national guidelines to manage pain a disconnect remains in in proper pain management resulting in undertreatment for about 50% of patients with moderate to severe pain(Wells et al., 2008). Inadequately managed pain can lead to an arsenal of negative adverse physical and psychological outcomes including immune system suppression resulting in infections and poor healing, sympathetic activation causing cardiac ischemia and ileus, reducing mobility resulting in deep vein thrombosis, as well as pulmonary embolus, or pneumonia(Nwachukwu, 2012). All mentioned adverse conditions carry along the potential consequence of extending a patient’s length of stay in the hospital decreasing patie nt satisfaction and increasing organizational costs(Nwachukwu, 2012). The Affordable Care Act of 2010 has established changes in the way hospitals are reimbursed for services. Value-based purchasing has come to the forefront in the healthcare industry with the centers for Medicare and Medicaid services (CMS) withholding full reimbursements for poor quality care or even nonpayment for patients readmitted within 30 days. Low patient satisfaction score indicators being tracked by CMS will not only affect an organization’s bottom line but also stand to lose its reputation(Wells et al., 2008). When pain is not managed properly through an organization’s pain management policy and procedure guideline the entire collaborative team responsible for managing a patient’s pain may be liable for legal action(Wells et al., 2008). Research Translated Into Practice The Agency for Healthcare Research and Quality (AHRQ) focuses on current issues, patient safety and quality of healthcare providing practitioners the best research for optimal patient outcomes. AHRQ is an active participant in pushing evidence forward into practice with its Translating Research Into Practice (TRIP) initiative to generate knowledge about evidence-based care and with the TRIP-II initiative the focus is on utilizing information technology to affect translational research and health policy (McGonigle Mastrian, 2012). The TRIP database is a clinical search engine designed to identify high-quality clinical evidence for clinical practice that utilizes contextual issues such as the magnitude of the health issue, economic costs of the problem, the reliability, relevance, and validity of the data along with the quality and consistency of the evidence (Glasgow Emmons, 2007). The authors in the pain assessment and pain management research study utilized the TRIP database probi ng for the terms â€Å"pain assessment† and â€Å"pain management† in the literature search, filtered only the English language and publications dated within the last 10 years, meta-analysis, practice guidelines, literature reviews, clinical trials, and random clinical trials (RCT). To use evidence in practice, the validity of research is evaluated on an evidential hierarchy that is defined and the value is assigned to the information source on a scale from 1 to 6, one being the highest evidence from a systemic review and six being the evidence from the opinion of experts(McGonigle Mastrian, 2012). The evidence table provided by the authors in the pain assessment and pain management study exhibits excellent research validity with multiple design types rating high on the evidential hierarchy scale listing. The authors utilized evidence from a meta-analysis study (Level 1), twelve RCT studies (Level 2), seven systematic literature reviews (Level 5), three literature rev iews (Level 6), and one qualitative massage study (Level 7)(Melnyk Fineout-Overholt, 2011). The RCT is considered the most reliable source of evidence in the hierarchy and the meta-analysis is the best quality evidence because it uses a multiple individual research studies to come to a consensus (McGonigle Mastrian, 2012). Practice Implications The implications of this TRIP intervention designed to increase the use of evidence-based practice (EBP) in pain assessment and management highlights scientific evidence for practitioners to augment their clinical decision-making. Recommendations for successful implementation of pain assessment and management include education, the utilization of appropriate tools in pain assessment, a multimodal analgesic approach, continuous evaluation, and an established organizational pain management guideline. Patient and family education has been a central recommendation regarding pain management prior to any surgical procedure in that comprehensive pain evaluations can uncover patient’s attitudes, beliefs, level of knowledge, and unrealistic expectations that can be addressed(Wells et al., 2008). Wells et al. (2008) found that frequent communication, shared goals, and shared knowledge in education contributed to better pain outcomes. The most critical aspect of proper pain management is assessing pain levels on a regular basis using a standard format, and in order to meet the patient’s needs pain should be reassessed after each intervention evaluating the effects and determining whether modification is needed(Wells et al., 2008). Based upon systematic reviews of pain quality improvement studies the emphasis has shifted from processes to outcomes where clinicians recognize and treat pain promptly, involve patients and families in pain management plans, adjust pain management plans as needed, and monitor processes and outcomes(Wells et al., 2008). Utilizing a multimodal approach for pain management is recommended which includes opioids, and non-opioids such as nonsteroidal anti-inflammatory drugs, and adjunct medications such as anticonvulsants can improve the safety of the therapy (Wells et al., 2008). With safety issues regarding the use of morphine, hydromorphone, and fentyal clinicians need to be educated about safe pain management to help prevent undertr eatment of pain and the resulting harmful effects. A series of systematic reviews indicate poor results and outcomes using the intramuscular route (IM) administering of an opioid analgesic (Wells et al., 2008). The IM route is painful, has an unreliable absorption time and can be dangerous since patients are often alone at the time of peak affect and can become excessively sedated, vomit, and aspiratenevertheless produces the poorest outcomes (Wells et al., 2008). Unfortunately,Wells et al. (2008) describe the evidence for nondrug techniques of pain management including relaxation, music, massage, heat and cold therapies are neither supportive nor consistent, are considered weak in reducing acute pain, and may not improve outcomes. Ample evidence revealed the appropriate use of analgesics with the proper drug at the correct interval can provide good pain relief for the majority of patients, and organizations should place their emphasis on improving assessments and administration tec hniques (Wells et al., 2008). The psychological, emotional, and financial toll of uncontrolled pain is monumental and everyone experiencing discomfort because of pain justly expects and needs to receive appropriate pain management. Research Implications The research provided supports the evidence-based treatments with analgesics in the management of pain, and appears to be effective in controlling acute pain. However, the undertreatment of acute pain remains prevalent due to the clinician’ behaviors, which includes inadequate pain knowledge, assessment skills and administration of analgesics (Wells et al., 2008). Krenzischek, Wilson, Newhouse, Mamaril, Kane (2004) also assert a lack of pain management knowledge and the reduced usage of clinical practice guidelines is a high contributor in poor pain management. Research is needed for effective strategies in changing clinician attitudes and behaviors that will result in better pain management for patients as well as non-drug therapies (Wells et al., 2008). Wells et al. (2008) asserts, â€Å"Lack of standardization of nondrug therapies is one of the drawbacks of the current literature† (p. 11). Integration of Informatics The authors of this study integrated informatics through data, information and knowledge to support clinicians and patients in their decision-making regarding the best practices in accomplishing favorable outcomes and to improve the quality of care through pain assessment and management. Wells et al. (2008) utilized the informatics infrastructure to seek and manage validated studies from various sources, capture proper demographic, treatment and outcome information, and the AHRQ to share project information, results, and insights. The informatics infrastructure is critical to EBP and promotes the use of clinical judgment and knowledge with procedures and protocols to what is scientifically proven rather than what is customary(McGonigle Mastrian, 2012). The paradigm of â€Å"this is the way I’ve done it for years â€Å"is no longer acceptable and it is upon clinicians to apply the aforementioned viable knowledge, experience, understanding, and insight derived from EBP throug h informatics to gain and synthesize the effervescent wisdom needed for high quality patient care and optimal outcomes. References Elos, S., Helvi, K. (2008). The qualitative content analysis process. Journal of Advanced Nursing, 62(1), 107-115. http://dx.doi.org/10.1111/j.1365-2648.2007.04569.x Glasgow, R., Emmons, K. (2007). How can we increase translation of research and to practice? Types of evidence needed. Annual Review of Public Health, 28, 413-433. http://dx.doi.org/10.1146/annurev.publhealth.28.021406.144145 Johnson, B., Christensen, L. (2008). Educational research: quantitative, qualitative, and mixed approaches. Thousand Oaks, CA: Sage Publications. Ju-Ling, H., Wen-Chu, W. (2013). Factors of accepting pain management decision support systems by nurse anesthetists. BMC Medical Informatics and Decision Making, 13(16), 1-13. http://dx.doi.org/10.1186/1472-6947-13-16 Krenzischek, D. A., Wilson, L., Newhouse, R., Mamaril, M., Kane, H. L. (2004). Clinical evaluation of the ASPAN pain and comfort clinical guideline. Journal of PeriAnesthesia Nursing, 19(3), 150-159. http://dx.doi.org/10.1016/j.jopan.2004.03.003 McGonigle, D., Mastrian, K. G. (2012). Nursing informatics and the foundation of knowledge (2nd ed.). Burlington, MA: Jones and Bartlett. Melnyk, B. M., Fineout-Overholt, E. (2011). Evidence-based practice in nursing and healthcare: A guide to best practice (2nd ed.). Philadelphia, PA: Lippincott, Williams and Wilkins. Nwachukwu, C. N. (2012). Decreasing pain and length of stay in the post anesthesia care unit (PACU) by implementing the ASPAN pain and comfort guidelines (Doctoral dissertation, The Catholic University of America). Retrieved from http://aladinrc.wrlc.org/bitstream/handle/1961/10269/Nwachukwu_cua_0043A_10311display.pdf?sequence=1 Wells, N., Pasero, C., McCaffery, M. (2008). Improving the quality of care through pain assessment and management. Rockville, MD: Agency for Healthcare Research and Quality.

Chromium Picolinate and Weight Loss :: Medical Drugs Medicine Papers

Chromium Picolinate and Weight Loss Chromium picolinate is a nutritional supplement that works to increase the efficiency of insulin to optimal levels. Gaining increased popularity in the United States, this supplement has been touted a miracle mineral, one advertised to have myriad effects including weight loss, mood enhancement, energy promotion, increase in life span, and even the prevention of acne (Krzanowski, 1996). The most common usage for chromium picolinate is as a weight loss aid; claims that this supplement can melt fat, drastically reduce appetite, and increase metabolism are rampant and account for the popularity of chromium picolinate in our diet-obsessed culture. Recently, the supplement has been marketed as a â€Å"safe alternative to steroids,† claiming to increase strength and lean muscle mass (Trent &Thieding-Cancel, 1995). Chromium picolinate is a common ingredient in many herbal weight-loss concoctions readily available for over-the-counter sale at the local drugstore or on the internet. However, because chromium picolinate is a nutritional supplement rather than a prescription drug, the Food and Drug Administration (FDA) cannot vouch for the accuracy of advertiser’s often remarkable claims (Krzanowski, 1996). Additionally, scientific research is generally unsupportive of the weight loss claims surrounding chromium picolinate; consumers must be aware of these discrepancies when making a decision to take this or any other nutritional supplement. what is chromium picolinate? This popular nutritional supplement is a combination of the element chromium and picolinic acid. Chromium is a naturally-occurring mineral, trace amounts of which are found in everyday foods like meat, poultry, fish, and whole-grain breads. When foods are processed, they are stripped of natural chromium, making American diets generally very low in chromium; studies estimate an average daily chromium consumption of 33 mcg. In 1968, it was demonstrated that when animals do not receive adequate levels of chromium, insulin is not optimally effective, and damage to insulin-dependent systems can occur (Schroeder, 1968). This led the FDA to recommend a daily chromium intake of approximately 130 mcg, as infinitesimal amounts of chromium are needed to aid the transport of blood glucose across cell membranes (http://www.oznet.ksu.edu/dp_fnut/_timely/CHROMIUM.htm). Combining chromium with picolinic acid simply aids in efficient chromium absorption, and it is this combined form that is popu lar on the diet market today. how does chromium picolinate work? After eating, the human body secretes the hormone insulin. In general, the primary function of insulin is to transport glucose to the body’s cells in order to provide energy that facilitates cell functioning.

Medea Reflectiv Statement

Ana Maksimovic IB English 11/ 3 Per. Ms Bachmann 03/11/2012 335 Words Reflective Statement Medea has lot information that is often not conspicuous to the reader. In Medea the place and time play a big role. The place matters because of the events that happen. The events are related to Gods and gods were mainly famous in Greece. If you would change the place the meaning of gods would lose its importance.Time is always relevant because the play was written a long time ago and it shows how life was back then. Nowadays the country people live in is owned by the state; however this was not always the case. Back in the time there were individual kings who had the power over their whole land/country. Hard to understand was when the characters in the play referred to goddesses. If someone doesn’t know what the God stands for it was a bit confusing. Also easy for me to understand was the role of women.Not that I understand that they don’t have the same right but if you compare t he equality between women and men now it is easy follow the concept how it was in Greece a long time ago. Definitely the role of women can still be related to nowadays even if the equality between men and women got better; it is still not on the same level even if it should. Also the fact that the children stay with their mom when the dad leaves kind of reminds me of today in the society.A really big connection between today and Medea is that men had the power over a country. They used to own their own country but that hasn’t changed that much because most presidents are still male. The technique of using the voice of the population during speeches or just conflicts is very interesting. This kind of technique shows you what the other people think and it also makes the conflict more clear and understanding. Also the way Euripides uses the dramatic irony gives the whole play the final touch.

Aldi Case Essay

Individual Action points included in the presentation8 Appendix8 Executive Report Group 9 was assigned with the Aldi case study for the Marketing Management assessment. I was assigned with the role of Group Leader by the members and also trusted with the work for the PowerPoint presentation slides as I stated that I have the proper knowledge. The role of the leader was taken seriously and I starting setting the meeting conditions and proposed and delegated the individual research subjects related to our group case study. The individual research I undertook for the Aldi case study was the defining the Lean concept and detail research of the Continuous Improvement concept. As a group leader I took the decision that all the individual pieces of research to be presented inside the group for all to acknowledge the management concepts used into making the company run lean processes and getting customer satisfaction. Personally I designed the slides and the structure, which was later slightly modified by John Vincent’s proposal. Together we practiced and we have presented remarkably at the final presentation. Within the presentation I exposed a summary of the theoretical concepts of Lean Production, Continuous Improvement, Time Based Management, JIT production and Total Quality Management and was followed by Medet Coban who presented the Economies of Scale Concept while in the closing part John Vincent presented the benefits of Lean Thinking concluded with a Market research regarding Aldi’s competitive advantage. Key areas of personal research and sources of information As part of the Group 9 which had as case study the food retailing company ALDI, the following areas of research have been identified: * Lean thinking philosophy * Lean production * Continuous Improvement * Just In Time Management * Total Quality Management * Economies of Scale. The research of these concepts was distributed among the group members for a more in depth research and understanding. The key areas of research that I undertook for the group activity were 1. Defining and understanding the concepts of Lean Thinking Philosophy and Lean Production 2. Continuous Improvement. Used as sources of information for the foundation of my research were the LSC Library where I am registered as a student and the internet research. Also the group used the information of the case study. The proportion of the Library research weighted aprox. 80% of the total personal research, while the case study information weighted 10% and the internet sources also about 10%. The book references will be found in the appendix at the end of this report. Key theoretical positions summary In the group presentation there were analyzed and presented the following theoretical issues: The Mission and the Objectives The Mission is established by the top management of a company. It represents the long term achievements that are wanted to be reached and the basic principles to be followed to get as close as possible to the proposed mission. These principles must be followed by all employees as they represent the company’s values and in time the will develop into the company’s culture. The Objectives or targets are meant to set the results of the activity that the company needs to achieve in order to accomplish the mission set at the beginning. They can be quantitative or qualitative but always they have to be SMART (Specific, Measurable, Attainable, Realistic and Time defined) In our presentation it was specified that the Aldi’s mission was established using the ideology Lean Thinking and that Aldi uses the same philosophy’s principles in order to achieve its business objective for growth and continuous improvement. Lean Thinking is the concept where efficiency is developed by the improvement of the quality while reducing the costs, time, space and effort. The concept is used most of the time interchangeable with the JIT concept. Lean Production is the process of organizing each process of an organization with the purpose of increasing the efficiency and minimizing the waste. Next there were presented the others concepts used as tools into achieving the lean processes as they were also presented in the case study: Continuous Improvement – relies on gradually improving the organization’s processes for a cumulative increased rate of performance improvement. A learning organization is also able to generalize the knowledge gained in the improvement process by its employees and then replicate it among them. Time Based Management – it’s a general approach meant to reduce the level of unproductive time of the business’ processes. It usually requires multi-trained staff and/or advanced technology but it leads to advantages like faster market adaptability and a faster new product development. Just in Time Production – the management system where a company provides its products/services only as demanded on the market. The benefits of JIT are the reduced cost of stock management (only the necessary stock needed to cover for potentially delay of the suppliers or the production itself), fast adaptability for the demands on the market and waste reduction. Total Quality Management – a general management concept that concludes that all the factors and the resources of the company should be used towards achieving long term success through customer satisfaction. Its philosophy is getting things done right the first time. Economies of Scale – is an effect of running the organization efficiently and applying also the previous concepts. It presumes that a company will increase their incomes with a larger production/activity while maintaining approximately the same level of costs by using its resources efficiently. Individual Key Conclusions First we learned about Lean Thinking concept and how important it is in today’s world to be efficient. Studying ALDI case study we analyzed and discovered that having a competitive advantage on the market is both beneficial for the company and the customers in the same time. ALDI’s competitive advantage was to offer the customers the high quality products at lower prices by using the efficiency concepts that allowed them to run their processes with the minimum waste and costs. The lean thinking was adopted by the top management and included in the mission statement and the business objectives as the strategy to deliver the business benefits to the stockholders and the customers. The efficiency concepts used are interchangeable and complementary and they all lead towards achieving economies of scale profitability. Continuous improvement – everybody in the organization is to accept the responsibility of their tasks and contribute to the efficiency of the organization by improving the process and the standards of the activity. Time Based Management – is the most efficient when the company relies on multi skilled trained staff and can be considered as one of the main results of the continuous improvement. Just In Time concept orientates the company’s activity towards the market requirements and allows it adapt its production volume, standards and diversity to the requirements of the customers. Total Quality Management is a global management concept that guides the entire organization’s activity towards achieving customer satisfaction and every process must be efficiently improved to meet the quality, price and customer service demanded by the consumer. Economies of scale are the primary result of the efficiency concepts that have been applied in an integrated manner towards improving the business processes and to deliver the customer satisfaction. This will achieve the long term durability and development of the company as the mission and the objectives are oriented. The practical issues that arose prior to the presentation were: * The difficulty into arranging a meeting were all the members be present and therefore making some of the group decisions just based on the judgement of the named leader. * The structure of the presentation was changed just on the last meeting as an intervention of one of the members. The risk of losing time into the preparation and repetition was bigger than the risk of the last minute change and therefore we adopted the idea. After having the Power point slides done there have been modifications into the presentation which there were not changed into the printed handout due to the lack of time. Key Critical Observations and Commentary The first impression regarding the case study was that I would have had rather as the group assessment the marketing research and the development of a new marketing strategy. The start of the work on this piece was delayed due to the uncertainty of what exactly we are supposed to do. However, working on this case study gave me the opportunity to remark that Marketing is an integrated component of the entire organizational structure even though the concepts were mostly about operational management. Discovering the management concepts like Continuous Improvement, Just In Time Management, Time Based Management or Total Quality Management made the group realize that the Marketing Strategy is more efficient when the company has its production and services oriented towards getting customer satisfaction. The individual assignment directions I found to be a little bit confusing. Key topics of personal learning They key topic that I personally learned as a result of undertaking the group assignment was the Continuous Improvement concept. I have learned that Continuous Improvement is one of the two improvement methods, the second one being Discontinuous Change or Business Process Innovation. While the second method has a rather radical approach and it’s mostly used as a final resort to adapt to the environment requirements, Continuous improvement relies on gradually improving the organization’s processes for a cumulative increased rate of performance improvement. The 3 steps in assuring CI are: 1. creating the appropriate environment – the Company must create an ambience where all employees adopt the organization’s values and then set up standard procedures for the improvement process. The most common procedure is Deming’s and Shewhart’s Plan Do Control Act cycle. 2. Involving everyone in the Organization – Company is responsible for the employees’ participation. They must train the staff in Statistical Programming Control and work teams to encourage employee participation as well as setting the objectives like Quality Costs Delivery Safety Moral. . Using the proper Problem Solving Skills – Company must make sure that all teams have the appropriate Problem Solving Skills for the process improvement they’re responsible for. Continuous Improvement also relates to the concept of Learning Organization which means that learning of individuals must be generalized and replicated inside the comp any to achieve the best optimum improvement performance. Executive Summary of The Group activity I consider that the team we created and the group assignment was successful due to the following factors: * The final presentation went well, as planned and everybody was happy of the result; * Each student had the opportunity to do a piece of research and then presenting it to the other members of the group which helped learn individually and also teach each other in an interactive manner; * Group relations were well linked and there were no complaints to each other inside the group. The presentation of the individual research increased everyone’s confidence of taken a real presentation on their own for different subjects and in different situations. Individual Action points included in the presentation The personal contribution towards the group presentation consists of: 1. I was firstly elected as the leader of the group. My role was taken seriously and I tried to set the best times for meetings and also tried to get everyone involved in the decisions and brainstorming proc ess 2. I suggested leads to be followed for the presentation. I divided the research subjects and made everyone responsible for their own piece of work. The summary of each subject of research was presented individually inside the group. 3. PowerPoint slides’ design and structure were set personally and each member has its contribution with the content of their research for one slide of presentation. 4. Created the speech for the piece of presentation I was involved and took an active role into the practice of the presentation by directing and suggesting improvements.